FEASIBILITY OF A COMMUNITY-BASED NAVIGATOR SUPPORT PROGRAM FOR CARE PARTNERS OF SERIOUSLY ILL VETERANS

Abstract We examined the feasibility and satisfaction of a short-term Veterans Health Administration (VHA)-based care partner support intervention delivered by trained navigators during COVID-19 through a single-arm interventional cohort feasibility study of a telephone-based care partner navigation intervention. Navigators (n=9) received the standard state curriculum online from a local community health worker training program plus an additional eight weeks of online role-specific training by the study team. Subsequently, navigators contacted care partners (n=30) of seriously ill veterans weekly via telephone over a 12-week period to assess social and practical needs, and connect care partners to appropriate community-based or VHA resources. All navigators (9 female; 1 male) and 17% of care partners were African-American (83% were Caucasian or other). Care partners were 90% female and 10% male; age range 41 to 80. In this telephone-based support program delivered to care partners by standard-trained navigators across 12 counties, care partners were overall very satisfied (x̄=4.69 out of 5, sd =.77) with their navigator’s responsiveness and social support throughout the 12-week course of the study. Navigators’ confidence increased over time (x̄=8.2 out of 10 (sd=1.14) to x̄=8.78 (sd=.97)), while their self-assessed effectiveness ratings lowered over time as they encountered real-life scenarios (x̄=8.5 (sd=1.43) to x̄=7.89 (sd=.93)). Navigators documented successful connections to services in the VHA and in care partners’ communities. Using remote navigators with minimal but standard training is a feasible and acceptable model of care partner support.


VISUALIZING VETERANS' CARE: UNDERSTANDING THE BREADTH OF OLDER VETERANS' PAID AND FAMILY SUPPORT NETWORKS
Emily Franzosa 1 , and Imran Ali 2 , 1. Icahn School of Medicine at Mount Sinai, New York City, New York, United States, 2. The New Jewish Home, New York City, New York, United States Many older veterans rely on a complex network of paid and unpaid caregivers to age safely at home.Medical records often only capture a primary family caregiver, giving medical teams a limited picture of veterans' supports at home as well as plans for contingency care.We tested a novel visual tool, care mapping, to better understand the scope of veterans' formal and informal support.We created collaborative care maps with 10 dyads/triads of veterans age 65+ eligible for VA-paid home care and their primary paid and family caregivers.We compared the maps to veterans' electronic medical records (EMRs) to explore care network structure, function and adequacy.Care maps identified substantially more care partners than EMRs, including functional, medical, socioemotional and spiritual supports such as family, paid aides, neighbors, Veterans' groups, faith communities, local businesses (pharmacies, food delivery), and social media.Veterans, family and paid caregivers described working together closely, with aides serving as a "third arm" to fill care gaps.Care was often mutual, as veterans described financial and emotional support they provided to family members, aides and their families, and friends.Participants also described these networks as dynamic and fluid, changing based on care needs and care partners' availability and skills.Identifying the range of support Veterans receive from family, paid aides, and their community may better help medical teams understand often overlooked community supports and relationships, identify care gaps and tailor home and community-based services where they are most effective and needed.Family caregivers and home care workers provide essential daily care for millions of older adults and individuals with disabilities across the United States-and together they constitute the backbone of home and community-based services (HCBS).In many cases, these unpaid and paid caregivers work closely together and share common knowledge, skills, experiences, and challenges.Yet the overlap and relationship between them remains relatively understudied.This session will describe the importance of strengthening the family caregiver/home care worker dyad and discuss promising developments in research, policy, and practice.We will then highlight a pilot training intervention designed to improve the shared knowledge and interpersonal competencies of family caregivers and home care workers.The intervention-Partnering to Improve Care: Direct Care Workers and Families-was developed by PHI (a national nonprofit research, public education, and consulting organization) in partnership with the Florida Pioneer Network, Home Instead, and Florida State University through the North and Central Florida Geriatrics Workforce Enhancement Partnership (GWEP).Informed by the PHI Coaching Approach®, the intervention consists of five parallel online training modules for family caregivers and for home care workers that utilize adult learner-centered teaching methods and reflect input from home care stakeholders.The modules portray common scenarios that family caregivers and home care workers face and aim to build communication and relationship skills that facilitate collaborative problem-solving and the provision of person-centered care.We will present key findings on the feasibility and acceptability of this intervention, discuss next steps in this research, and highlight broader policy and practice recommendations.
Abstract citation ID: igad104.1523We examined the feasibility and satisfaction of a shortterm Veterans Health Administration (VHA)-based care partner support intervention delivered by trained navigators during COVID-19 through a single-arm interventional cohort feasibility study of a telephone-based care partner navigation intervention.Navigators (n=9) received the standard state curriculum online from a local community health worker training program plus an additional eight weeks of online role-specific training by the study team.Subsequently, navigators contacted care partners (n=30) of seriously ill veterans weekly via telephone over a 12-week period to assess social and practical needs, and connect care partners to appropriate community-based or VHA resources.All navigators (9 female; 1 male) and 17% of care partners were African-American (83% were Caucasian or other).Care partners were 90% female and 10% male; age range 41 to 80.In this telephone-based support program delivered to care partners by standard-trained navigators across 12 counties, care partners were overall very satisfied (x=4.69 out of 5, sd =.77) with their navigator's responsiveness and social support throughout the 12-week course of the study.Navigators' confidence increased over time (x=8.2out of 10 (sd=1.14) to x=8.78 (sd=.97)), while their self-assessed effectiveness ratings lowered over time as they encountered real-life scenarios (x=8.5 (sd=1.43)Family caregivers, paid caregivers, and geriatricians frequently work together to care for people with dementia living at home, yet little is known about the paid caregiver role in home-based dementia care.We conducted repeated, one-on-one, semi-structured interviews with the care team (i.e., family caregiver, paid caregiver, geriatrician) of 9 people living at home with dementia over 6 months to explore multiple perspectives on paid caregivers' role in care over time.In all, 29 unique respondents participated in 75 interviews that were analyzed using the framework method of analysis.Results revealed nuanced and highly individual care arrangements where paid caregiver roles in care varied significantly, though changes to this role over time were minimal.Families were the key players in defining the paid caregivers' role regardless of home care agency involvement or source of paid caregiver payment (i.e., Medicaid-funded vs. privately paid) and geriatricians frequently deferred to family caregivers to determine how they should engage with paid caregivers.While paid caregivers often described their emotional connection to their clients, family caregivers and geriatricians rarely described this as an important aspect of paid care.To meet the nuanced care needs of people with dementia, home care needs to be centered around the unique needs of both people with dementia and their family caregivers.Rather than provide prescriptive standards for home care, familycentered home care should facilitate improved communication and clear expectation setting to be sure that care best meets the unique care needs of people with dementia living at home.

PRAGMATIC IMPLEMENTATION OF AN ADVANCE CARE PLANNING INTERVENTION: FINDINGS FROM SHARING CHOICES
Chair: Daniel Scerpella Co-Chair: Jennifer Wolff Discussant: Joseph Gaugler Advance care planning (ACP) is defined as a key task in ambulatory care for patients to share values, goals, and preferences for future medical care.Ideally ACP is revisited throughout the course of serious illness and engages family in discussions with clinicians.Most interventions, however, have not targeted primary care as a setting for ACP but have instead targeted a specific illness, conversation or setting such as the inpatient hospital or nursing home.Additionally, family is often not included in ACP discussions.This symposium will discuss critical components of the SHARING Choices cluster-randomized pragmatic trial, including the setup, monitoring, and analysis of this intervention within two primary care health systems located in the Baltimore-Washington DC metropolitan corridor.Each presenter will discuss key efforts conducted during the trial that highlight challenges, lessons learned, and novel approaches of embedding an evidence-based intervention within usual care settings targeting older adults 65 years of age and older.Preliminary analyses indicate that the ACP intervention was highly effective for increasing the likelihood of having advance directives in the patients' electronic health records within 1-year of intervention initiation (odds ratio = 2.88, p < 0.001).Attendees of this symposium will take away relevant insights for implementing effective ACP and communication interventions within primary care settings as well as supporting outcome data.Our discussant will provide thoughts on the implications of these results for current primary care organizations and in the field of ACP and communication for older adults including those with dementia.

PARTNERING TO IMPROVE CARE: STRENGTHENING THE FAMILY CAREGIVER AND HOME CARE WORKER RELATIONSHIP Kezia
Nathan Boucher 1 , Hollis Weidenbacher 2 , Madeleine Eldridge 2 , Kimberly Johnson 3 , Courtney Van Houtven 4 , Karen Steinhauser 5 , and Kelli Allen 2 , 1. Veterans Health Administration/Duke University, Durham, North Carolina, United States, 2. Durham VA Health care System, Durham, North Carolina, United States, 3. Duke University, Durham, North Carolina, United States, 4. Duke University School of Medicine, Durham, North Carolina, United States, 5. Duke/Durham VA, Durham, North Carolina, United States

THE NEED FOR FAMILY-CENTERED HOME CARE IN HOME-BASED DEMENTIA CARE Jennifer
to x=7.89 (sd=.93)).Navigators documented successful connections to services in the VHA and in care partners' communities.Using remote navigators with minimal but standard training is a feasible and acceptable model of care partner support.Reckrey 1 , Deborah Watman 1 , and Emma Tsui 2 , 1. Icahn School of Medicine at Mount Sinai, New York City, New York, United States, 2. CUNY Graduate School of Public Health, New York, New York, United States